干眼的影响因素及其临床诊断价值探讨

doi:10.11958/20220589

摘要/Abstract

摘要：

目的探讨干眼患者发生干眼的影响因素及临床诊断价值。方法收集160例干眼患者，包括轻度干眼组51例，中度干眼组61例，重度干眼组48例，另取健康体检者55例为对照组。干眼分析仪检测各组第1次泪膜破裂时间（NIBUTf）、平均泪膜破裂时间（NIBUTav）、泪膜脂质层厚度（LLT）、泪河高度（LTMH）和结膜充血评分。对各组进行眼表疾病指数（OSDI）量表评分、角膜荧光染色（FL）评分、泪液分泌试验（SⅠt）检查，采用酶联免疫吸附试验检测泪液中白细胞介素17（IL-17）、基质金属蛋白酶9（MMP-9）水平，通过单因素和多因素Logistic回归分析干眼的影响因素。结果对照组、轻度干眼组、中度干眼组、重度干眼组NIBUTf、NIBUTav、LLT、LTMH、SⅠt呈依次降低趋势，IL-17、MMP-9、OSDI评分、FL评分呈依次升高趋势（均P<0.05）。重度干眼组的结膜充血评分高于对照组和轻度干眼组（均P<0.05）。Logistic回归分析显示，较高水平LLT、LTMH是患者发生干眼的保护因素，较高水平IL-17、MMP-9是患者发生干眼的危险因素。受试者工作特征曲线分析显示，各单独指标诊断时，以LLT综合优势较为明显，IL-17诊断特异度较高，但各指标联合诊断的优势最为明显。结论较高水平的LLT、LTMH是患者发生干眼的保护因素，较高水平的IL-17、MMP-9是患者发生干眼的危险因素，4个指标联合检测有助干眼的辅助诊断。

关键词: 干眼综合征, 早期诊断, 白细胞介素17, 基质金属蛋白酶9, 泪膜脂质层厚度, 泪河高度

Abstract:

Objective To explore the influencing factors and clinical diagnostic value of dry eyes in patients with dry eye syndromes. Methods A total of 160 patients with dry eye were collected，including the mild dry eye group (n=51), the moderate dry eye group (n=61) and the severe dry eye group (n=48). Another 55 healthy subjects were selected as the normal control group. Data of the first tear film rupture time (NIBUTf), mean tear film rupture time (NIBUTav), tear film lipid layer thickness (LLT), lacrimal river height (LTMH) and conjunctival congestion score were detected by dry eye analyzer SLM-KD3. The ocular surface disease index (OSDI) scale score, corneal fluorescent staining score (FL) and tear secretion test (Slt) were performed in each group. Interleukin-17 (IL-17) and matrix metalloproteinase-9 (MMP-9) in tears were detected by enzyme-linked immunosorbent assay (ELISA). Univariate and multivariate Logistic regression were used to analyze influencing factors of dry eye. Results NIBUTf, NIBUTav, LLT, LTMH and SIt decreased in turn in the control group, the mild dry eye group, the moderate dry eye group and the severe dry eye group, while IL-17, MMP-9, OSDI and FL scores increased in turn (P<0.05). The score of conjunctival congestion was higher in the severe dry eye group than that in the control group and the mild dry eye group (P<0.05). Logistic regression analysis showed that higher levels of LLT and LTMH were protective factors for dry eyes, while higher levels of IL-17 and MMP-9 were risk factors for dry eyes. ROC analysis showed that when each individual index was diagnosed, the comprehensive advantage of LLT was more obvious, and the diagnostic specificity of IL-17 was higher, and the advantage of combined diagnosis of each index was the most obvious. Conclusion Higher levels of LLT and LTMH are protective factors for dry eyes, while higher levels of IL-17 and MMP-9 are risk factors for dry eyes. The combined detection of the four indexes is helpful in the diagnosis of dry eyes.

Key words: dry eye syndromes, early diagnosis, interleukin-17, matrix metalloproteinase 9, lipid layer thickness, lacrimal tear meniscus height

中图分类号:

R777.34

图/表 7

参考文献 28

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组别	n	性别（男/女）	年龄（岁，$\bar{x}±s$）
对照组	55	23/32	56.78±9.33
轻度干眼组	51	17/34	54.14±7.92
中度干眼组	61	21/40	57.08±7.78
重度干眼组	48	22/26	55.08±10.29
χ²或F		2.345	1.360

组别	n	性别（男/女）	年龄（岁，$\bar{x}±s$）
对照组	55	23/32	56.78±9.33
轻度干眼组	51	17/34	54.14±7.92
中度干眼组	61	21/40	57.08±7.78
重度干眼组	48	22/26	55.08±10.29
χ²或F		2.345	1.360

组别		n	NIBUTf（s）		NIBUTav（s）		LLT（级）
对照组		55	10.52±1.14		12.44±1.12		4.62±1.01
轻度干眼组		51	7.33±1.98^a		8.47±1.08^a		3.37±0.96^a
中度干眼组		61	5.49±1.52^ab		6.71±1.82^ab		2.38±0.82^ab
重度干眼组		48	3.27±1.45^abc		3.19±1.10^abc		1.58±0.58^abc
F			206.558^＊＊		423.133^＊＊		121.520^＊＊
组别	LTMH （mm）			SⅠt （mm）		IL-17 （ng/L）		MMP-9 （μg/L）
对照组	0.23±0.09			11.81±2.08		66.25±8.93		37.75±8.18
轻度干眼组	0.17±0.07^a			8.45±2.45^a		79.83±12.68^a		44.28±5.16^a
中度干眼组	0.15±0.04^ab			5.48±1.89^ab		86.54±11.86^ab		49.46±11.94^ab
重度干眼组	0.12±0.03^abc			2.23±1.04^abc		93.16±10.31^abc		54.59±7.11^abc
F	33.295^＊			229.947^＊＊		57.238^＊		36.048^＊

组别		n	NIBUTf（s）		NIBUTav（s）		LLT（级）
对照组		55	10.52±1.14		12.44±1.12		4.62±1.01
轻度干眼组		51	7.33±1.98^a		8.47±1.08^a		3.37±0.96^a
中度干眼组		61	5.49±1.52^ab		6.71±1.82^ab		2.38±0.82^ab
重度干眼组		48	3.27±1.45^abc		3.19±1.10^abc		1.58±0.58^abc
F			206.558^＊＊		423.133^＊＊		121.520^＊＊
组别	LTMH （mm）			SⅠt （mm）		IL-17 （ng/L）		MMP-9 （μg/L）
对照组	0.23±0.09			11.81±2.08		66.25±8.93		37.75±8.18
轻度干眼组	0.17±0.07^a			8.45±2.45^a		79.83±12.68^a		44.28±5.16^a
中度干眼组	0.15±0.04^ab			5.48±1.89^ab		86.54±11.86^ab		49.46±11.94^ab
重度干眼组	0.12±0.03^abc			2.23±1.04^abc		93.16±10.31^abc		54.59±7.11^abc
F	33.295^＊			229.947^＊＊		57.238^＊		36.048^＊

组别	n	OSDI评分	结膜充血评分	FL评分
对照组	55	9.78±2.02	1.47±0.43	0.86±0.40
轻度干眼组	51	15.16±2.90^a	1.48±0.47	4.45±1.51^a
中度干眼组	61	23.72±3.29^ab	1.57±0.50	7.84±2.84^ab
重度干眼组	48	35.54±4.05^abc	1.72±0.61^ab	9.52±1.95^abc
F		656.595^＊＊	2.730^＊	210.755^＊＊